Expert: Claes-Gustaf Nordquist, M.D. - 3/20/2006

Question
Dear Doctor,

My father was diagnosed of colon cancer in November, 2004, and received surgery to remove tumor and 13 lymph nodes. The tumor in right part of colon had spread outside the wall of his colon, but all removed lymph nodes tested negative. After surgery, he received chemotherapy using Oxaliplatin and 5-Fu. His preoperative CEA was not tested. His postoperative CEA was 1.4. Since then, his CEA was getting higher slowly and was > 5 in June, 2005. He received chemotherapy using Oxaliplatin and 5-Fu again in September but his CEA reached 19. At this time, he was diagnosed of small intestine cancer and received surgery again to remove tumor. The pathology of small intestine cancer is similar to last time. The doctor could not tell us if his small intestine tumor was recurrent or concomitant. Opposite to my expectation, his CEA is even higher two months after the second surgery, rushing to 50. However, CT and ultrasound indicated that his liver is normal and X-rays showed that his lung is normal. Currently, we really do not know what we should do next for my dad. Is it necessary for him to take chemotherapy again? Since he is not sensitive to Oxaliplatin, what else chemotherapy agents can he use? Does my dad¡¯s CEA count really mean recurrence of cancer? I appreciate your reply. Thank you!

Answer
In the absence of other signs of tumour disease CEA is all you have so it is very difficult to be sure if it really reflect further tumour spread. It is probable that it does, but I can not be sure.I do not know where you are and I'm in Sweden, so I do not know what chemo therapy drugs that are available where you are. I therefore recommend that you discuss that matter with his dr. The only route I can recommend is more chemotherapy - if possible, but of course it is impossible to promise results unfortunately.